胸椎黄韧带骨化症切开手术减压与脊柱内镜微创减压术的疗效对比

胸椎黄韧带骨化（ossified ligamentum flavum, OLF）严重者会导致胸椎管狭窄症，压迫脊髓导致下肢感觉、运动功能障碍，传统手术方案选择是开放式椎板切除术。与开放减压相比，微创方法和脊柱内窥镜手术降低了围手术期的发病率[1,2]。内窥镜脊柱手术应用已经从早期的腰椎间盘切除术发展到目前针对各种退行性疾病的治疗[3-8]。

Ruetten 等人[9]描述了一种单孔全内镜治疗椎管狭窄的胸椎减压技术，该技术具有良好的临床效果。其他文献报道了经椎间孔入路对胸椎管狭窄症和椎间盘脱垂进行内镜减压的成功病例[10-12]。

然而仍缺乏文献来评估内镜下胸椎单侧椎板切开双侧减压术（thoracic endoscopic unilateral laminotomy with bilateral decompression, TE-ULBD）和常规胸椎开放式双侧椎板切开减压术（thoracic open laminotomy,TOL）在临床结果和磁共振影像上的减压效果。

近期有学者发表回顾性研究[13]，对比评估接受TE-ULBD与TOL的胸椎管狭窄减压术后患者，评估两种术式临床结果与MRI影像学变化。将35个TE-ULBD与24个TOL进行了比较。

胸5-6右侧黄韧带骨化，TE-ULBD手术演示

TOL的总体并发症发生率为 15%，而TE-ULBD为6.5%。TOL 和 TE-ULBD 队列在术后均显着改善了各自的视觉模拟量表 (VAS)、Oswestry 残疾指数和日本骨科协会 (JOA) 脊髓病评分。TE-ULBD在改善最终VAS和JOA分数方面显著优于 TOL。平均Hirabayashi恢复率分别为94.5% (TE-ULBD) 和56.8% (TOL)。两组在术前和最终随访时，Oswestry残疾指数和上终板、椎间盘和下终板水平的MRI横截面积变化方面无统计学差异。

胸9-10黄韧带骨化患者MRI，术前（A-D）与微创TE-ULBD术后（E-H）对比

胸11-12黄韧带骨化患者MRI，术前（A-D）与开放TOL术后（E-H）对比

胸椎管狭窄症患者，不论采取传统的切开减压（OLF）还是微创脊柱内镜减压（TE-ULBD）均取得了满意的术后症状学和影像学效果。与胸椎开放椎板切除术相比，TE-ULBD通过充分的椎管减压显著改善了疼痛和神经功能。

在胸椎黄韧带骨化导致的椎管狭窄的术式选择上，对于已经克服了脊柱内窥镜手术陡峭学习曲线的外科医生来说，TE-ULBD是一种可行的、侵入性较小的微创术式选择。

参考文献

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2. Seng C, Siddiqui MA, Wong KP, et al. Five-year outcomes of minimally invasive versus open transforaminal lumbar interbody fusion: a matched-pair comparison study. Spine (Phila Pa 1976). 2013;38(23):2049-2055.

3. Kim HS, Wu PH, Lee YJ, et al. Safe route for cervical approach: partial pediculotomy, partial vertebrotomy approach for posterior endoscopic cervical foraminotomy and discectomy. World Neurosurg. 2020;140:e273-e282.

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10. Jia ZQ, He XJ, Zhao LT, Li SQ. Transforaminal endoscopic decompression for thoracic spinal stenosis under local anesthesia. Eur Spine J. 2018;27(suppl 3):465-471.

11. Wu PH, Kim HS, Raorane HD, et al. Safe extraforaminal docking and floating technique in transforaminal endoscopic discectomy for thoracolumbar junction for calcified disc herniation: a case report and technical review junction for calcified disc herniation. J Minim Invasive Spine Surg Tech. 2020;45(1):26-30.

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13. Kim HS, Wu PH, Kim JY, Lee YJ, Kim DH, Lee JH, Jeon JB, Jang IT. Comparative Clinical and Radiographic Cohort Study: Uniportal Thoracic Endoscopic Laminotomy With Bilateral Decompression by Using the 1-Block Resection Technique and Thoracic Open Laminotomy With Bilateral Decompression for Thoracic Ossified Ligamentum Flavum. Oper Neurosurg (Hagerstown). 2022 Apr 5. doi: 10.1227/ons.0000000000000145.

来源：脊柱甘露语林

作者：甘露语林学术

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